Surgical Pathology Criteria

Osteosclerotic Myeloma

Differential Diagnosis

Osteosclerotic Myeloma Myeloma Plasmacytoma
Osteosclerotic lesion Osteolytic lesions Osteolytic lesion
<5% plasma cells usually >> 5% plasma cells < 5% plasma cells
POEMS syndrome present No POEMS syndrome No POEMS syndrome
Castleman like node changes may be present No Castleman changes No Castleman changes
  • POEMS = Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, Skin changes
  • Hematolymphoid Disorders with Marrow Fibrosis (overview)

    Disorder Distinguishing Feature(s)
    Polycythemia Vera, Fibrotic Phase History of PV / JAK2+
    Essential Thrombocythemia, Fibrotic Phase (rare) History of ET / may be JAK2+
    CML, Fibrotic Phase History of CML / BCR-ABL1+
    MDS with Fibrosis Dysplastic features in marrow
    Acute Megakaryoblastic Leukemia Blasts, acute onset
    Osteosclerotic Myeloma Plasma cells. light chain restricted
    Acute Pan-myelosis with Myelofibrosis Bone pain, acute onset
    Primary Myelofibrosis Clustered atypical megakaryocytic hyperplasia
    Hairy cell leukemia Clonal B cells
    MDS with Fibrosis = descriptive term that includes primary MDS (often RAEB2) with fibrosis and therapy related myeloid neoplasms with fibrosis

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